Effects of L-Arginine on the Change of Myocardial Stunning

Chang Gyu Park; Seong Whan Han; Eun Mi Lee; Dong Gyu Jin; Young Hoon Kim; Do Sun Yim; Hong Seog Seo; Wan Ju Shim; Dong Ju Oh; Young Moo Ro

doi:10.3803/jkes.1996.4.1.5

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Park, Han, Lee, Jin, Kim, Yim, Seo, Shim, Oh, and Ro: Effects of L-Arginine on the Change of Myocardial Stunning

Original Article

J Korean Soc Echocardiogr 1996;4(1):5-12.

Published online: 18 February 1996

DOI: https://doi.org/10.3803/jkes.1996.4.1.5

Effects of L-Arginine on the Change of Myocardial Stunning

Chang Gyu Park, M.D., Seong Whan Han, M.D., Eun Mi Lee, M.D., Dong Gyu Jin, MD., Young Hoon Kim, M.D., Do Sun Yim, M.D., Hong Seog Seo, M.D., Wan Ju Shim, M.D., Dong Ju Oh, M.D., Young Moo Ro, M.D.

Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The effects of L-arginine-NO system on myocardial stunning haven't been well known. This work was designed to know whether L-arginine, physiologic NO precusor, would attenuate postischemic myocardial dysfunction or not. To investigate whether intravenous administration of L-arginine, physiological nitric oxide(NO) precursor, during reperfusion would attenuate postischemic myocardial dysfunction, 18 open-chest dogs were studied.

Methods

In 18 pentobarbital anesthesized open-chest dogs, left circumflex coronary artery was occluded for 20 minutes and was followed by a reperfusion for 60 minutes. L-Arginine (30mg/kg)(L-arginine group, n=8) or saline(control group, n=10) was infused intravenously 1 minute before reperfusion and was followed by a continuous infusion(10mg/kg/min) for 30 minutes during reperfusion. Before coronary occlusion and 30 minutes and 60 minutes after reperfusion, coronary blood flow(CBF) and coronary vascular resistance(CVR) were measured. Myocardial segment thickening in the area of ischemia-reperfusion was measured using 2D-echocardiography. The echocardiographic images were digitized and analyzed by cardiac image analyzer.

Results

1) Percent change of CBF was decreased by 42.5% in L-arginine group but it was increased by 1.3% in control group(p=0.025) and %change of CVR was increased by 83.5% in L-arginine group vs 11% in control group after 60 minutes of reperfusion, compared with pre-occlusion baseline valucs(p=0.06).

2) Percent change of myocardial segment thickening was decreased both in L-arginine group (by 69.5%) and control group(by 57.6%) after reperftision 30 minutes without statistically significance, but it was significantly decreased in L-arginine group(by 80%) compared with control group(by 55.6%) after reperftision 60 minute(p=0.01).

Conclusion

The findings that the administration of L-arginine cause significant depression of post-ischemic myocardial contractile function after reperftision 60 minutes suggests that systemic infusion of L-arginine has an unfavorable effect on myocardial stunning and low reflow phenomenon. These results suggest that L-arginine may have independent deteriorating effects on myocardial stunning after reperftision 60 minutes.

Keywords: L-arginine, Stunning, Nitric oxide.

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Fig. 1.

Experimental protocol.

Fig. 2.

Change of coronary blood flow(CBF) at baseline and reperfusion 60minute in control group and L-arginine group.

Fig. 3.

%Δ change(vs baseline) of peak coronary blood flow(CBF) and peak coronary vascular resistance (CVR) in control group and L-arginine group.

Fig. 4.

Change of coronary vascular resistance(CVR) at baseline and reperfusion 60minute in control group and L-arginine group.

Fig. 5.

Change in segmental %myocardial thickening(% TH) before and after occlusion(Occl) and reperfusion(Rep), ^∗: p<0.05

Fig. 6.

%Δ change(vs baseline) of myocardial thickening fraction in control group and L-arginine group at reperfusion 30minute and 60minute.

Table 1.

Hemodynamic data

	Baseline	Reperfusion 60min
HR(bpm)
L-Arginine	155 ± 15	105 ± 21^∗
Control	143 ± 20	111 ± 25
MBP(mmHg)
L-Arginine	95 ± 18	88 ± 14
Control	91 ± 10	87 ± 7

MBP: mean blood pressure,

^∗ : p<0.05 vs baseline

Table 2.

Coronary blood flow(CBF) and coronary vascular resistance(CVR) at baseline and reperfusion 60 minutes

	Baseline	Rep60min	%Change@
CBF(ml/min)
L-Arg	39 ± 9.7	23 ± 12.7^∗	–42.5 ± 30^∗∗
Control	32.6 ± 15.4	29.9 ± 7.9	1.3 ± 42.9
CVR
L-Arg	2.5 ± 0.7	4.7 ± 2.1^∗	83.5 ± 68.5^†
Control	3.26 ± 1.3	2.87 ± 1.1	11 ± 78

@: (Rep60-Base)/Basex 100

^∗ : p<0.05 vs baseline,

^∗∗ : p=0.025,

^† : p=0.06 vs control

Table 3.

%changes of segmental %endocardial and % myocardial thickening before and after occlusion(Occl) and reperfusion(Rep)

	Basal	Occl	Rep30min	Rep60min
%Endocardial thickening
L-Arg	7.7 ± 3.5	0.2 ± 1.6^∗	2.0 ± 1.9^∗	2.0 ± 1.9^∗
Control	7.3 ± 2.3	–1.9 ± 2.2^∗	3.0 ± 1.7^∗	3.1 ± 1.7^∗
%Total myocardial thickening
L-Arg	81.5 ± 33.1	–4.3 ± 9.4^∗	23.4 ± 20.8^∗	17 ± 1^∗
Control	89.2 ± 19.7	–25 ± 16.3^∗	35.3 ± 13.5^∗	39 ± 19^∗

^∗ : p<0.01 vs basal

Table 4.

%decrease myocardial thickening after reperfusion 30minutes & reperfusion 60minutes between control group & L-arginine group

	Rep 30min	Rep 60min
L-Arg	69.5 ± 28	80 ± 13.4^∗
Control	57.6 ± 27	55.6 ± 22.1

L-Arg: L-arginine,

^∗ : p=0.01 vs control

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